title: Computed tomography image processing to detect the real mechanism of bioprosthesis failure: implication for valve-in-valve implantation.
abstract: OBJECTIVE
  Transcatheter valve-in-valve implantation is an emerging option for patients with structural deterioration of an aortic bioprosthesis and who are at a high surgical risk. The present case underlines the need for dedicated imaging to accurately understand the mechanism of valve failure, and the feasibility of a valve-in-valve procedure.
  
  
  METHODS
  A patient with structural bioprosthetic deterioration at echocardiography was investigated using computed tomography (CT) scanning and novel 3D slicer software. The findings were compared with those revealed at intraoperative pathology.
  
  
  RESULTS
  Post-processed CT images showed the bulk of calcifications to be located at the subvalvular level, suggesting the presence of calcified pannus. Pathology of the explanted valve confirmed that the valve stenosis was due primarily to pannus. Misdiagnosed calcified pannus represents a major threat during valve-in-valve procedures, due mainly to embolic risk.
  
  
  CONCLUSIONS
  The 3D slicer elaboration of CT images may be invaluable in providing a precise definition of the mechanism of valve failure, and also to establish the feasibility of either a valve-in-valve procedure or conventional surgery.
authors.affiliation: Department of Cardiovascular and Thoracic Surgery, Pontchaillou University Hospital, Rennes, France. gianvito_ruggieri@libero.it
authors.forename: Vito Giovanni
authors.initials: VG
authors.lastname: Ruggieri
authors.forename: Amedeo
authors.initials: A
authors.lastname: Anselmi
authors.forename: Qian
authors.initials: Q
authors.lastname: Wang
authors.forename: Simon
authors.initials: S
authors.lastname: Esneault
authors.forename: Pascal
authors.initials: P
authors.lastname: Haigron
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Verhoye
mesh_terms: D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging* / Q000601:surgery; D002114:Calcinosis / Q000000981:diagnostic imaging* / Q000601:surgery; D019544:Equipment Failure Analysis / Q000379:methods; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D011475:Prosthesis Failure; D012086:Reoperation / Q000379:methods; D014057:Tomography, X-Ray Computed